Otolaryngology Coding Alert

Question: I interpret the December 2006 Otolaryngology Coding Alert -Reader Question: Apply Medicare Guideline to Bilateral Repair- to mean that we can bill for both 69424 bilaterally and 69610 bilaterally at the same session. Is this correct?

When we do this, insurers deny 69424-50 with an explanation that the tube change is incidental to the repair and that the National Correct Coding Initiative edits indicate no modifier is allowed.

Illinois Subscriber Answer: The reader question does not state that you should bill both together.

Instead: The article said you should report 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch) bilaterally (modifier 50, Bilateral procedure), but it did not state you should also report the ventilating tube removal (69424-50, Ventilating tube removal requiring general anesthesia). In fact, you should not report the 69424-50 described in the question. You should report only the repair, as the answer indicates.

Bottom line: The repairs cannot be done without removing the ventilating tubes. Therefore, the tympanic membrane repairs (69610-50) include the tube removals (69424-50). You should not bill these together -- and insurers are correct to deny 69424-50 because the tube change is incidental to the repair.